Skip to main content
SpringerLink
Log in

Infection rate and risk factors associated with infections related to external ventricular drain

  • Brief Report
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Objective

To describe incidence rates and risk factors associated with external ventricular drain (EVD)-related infections at a tertiary Brazilian teaching hospital.

Methods

The patient cohort consisted of all patients at a major teaching hospital in Brazil with an EVD during the period 1 April 2007 to 30 June 2008 (15 months). Patients were followed up for 30 days after catheter removal. According to the Center for Diseases Control and Prevention criteria for meningitis/ventriculitis, all of the central nervous system (CNS) infections that occurred during this period could be considered to be meningitis or ventriculitis related to EVD placement. Infection rates were calculated using different denominators, such as (1) per patient (incidence), (2) per procedure, and (3) per 1,000 catheter-days (drain-associated infection rate). Patient demographic data, medical history of underlying diseases, antibiotic prophylaxis usage, American Society of Anesthesiologists Score classification, duration of surgery and hospitalization, length of time the EVD was in place, and overall mortality were evaluated during the study period. A logistic regression model was developed to identify factors associated with infection.

Results

A total of 119 patients, 130 EVD procedures, and 839 catheter-days were evaluated. The incidence of infection was 18.3%, the infection rate was 16.9% per procedure, and the drain-associated infection rate was 22.4 per 1,000 catheter-days; 77% of the infections were caused by Gram-negative micro-organisms. Only 75% of patients received antibiotic prophylaxis. The infection rate increased with length of the hospital stay. The length of time the catheter was in place was the only independent risk factor associated with infection (p = 0.0369).

Conclusion

The incidence of EVD-related infections is high in our hospital, Gram-negative micro-organisms were the most frequent causal agents identified and length of time that the catheter was in place contributed to the infection rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Maniker AH, Vaynman AY, Karimi RJ, Sabit AO, Holland B. Hemorrhagic complications of external ventricular drainage. Neurosurgery. 2006;59:419–25.

    Article  Google Scholar 

  2. Arabi Y, Memish ZA, Balkhy HH, Francis C, Ferayan A, Al Shimemeri A, et al. Ventriculostomy-associated infections: incidence and risk factors. Am J Infect Control. 2005;33:137–43.

    Article  PubMed  Google Scholar 

  3. Korinek AM, Reina M, Boch AL, et al. Prevention of external ventricular drain-related ventriculitis. Acta Neurochir (Wien). 2005;147:39–46.

    Article  Google Scholar 

  4. Spaho N, Camputaro L, Salazar E, et al. Guias de práctica clínica para el manejo del drenaje ventricular externo. Rev Argent Neuroc. 2006;20:43–6.

    Google Scholar 

  5. Lo CH, Spelman D, Bailey M, et al. External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg. 2007;106:378–83.

    Article  PubMed  Google Scholar 

  6. Pfisterer W, Mühlbauer M, Czech T, et al. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry. 2003;74:929–32.

    Article  PubMed  CAS  Google Scholar 

  7. Ehtisham A, Taylor S, Bayless L, et al. Placement of external ventricular drains and intracranial pressure monitors by neurointensivists. Neurocrit Care. 2009;10:241–7.

    Article  PubMed  Google Scholar 

  8. Scheithauer S, Bürgel U, Ryang YM, Haase G, Schiefer J, Koch S, et al. Prospective surveillance of drain-associated meningitis/ventriculitis in a neurosurgery and a neurologic intensive care unit. J Neurol Neurosurg Psychiatry. 2009;80:1381–5.

    Article  PubMed  CAS  Google Scholar 

  9. Lew DP, Pittet D, Waldvogel FA. Infection that complicate the insertion of prosthetic devices. In: Mayhall CG (ed) Hospital epidemiology and infection control. 3rd edn. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 1196.

    Google Scholar 

  10. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infec Control. 1988;16:128–40.

    Article  CAS  Google Scholar 

  11. National Committee for Clinical Laboratory Standards (NCCLS). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically 2000, 5th edn. Approved standard M7-A5. NCCLS, Wayne.

  12. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2008;2:688–700.

    Google Scholar 

  13. Petignat C, Francioli P, Harbarth S, Regli L, Porchet F, Reverdin A, et al. Cefuroxime prophylaxis is effective in noninstrumented spine surgery: a double-blind, placebo-controlled study. Spine. 2008;33:1919–24.

    Article  PubMed  Google Scholar 

  14. Holloway KL, Smith KW, Wilberger JE Jr, Jemsek JG, Giguere GC, Collins JJ. Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime. Clin Ther. 1996;18:84–94.

    Article  PubMed  CAS  Google Scholar 

  15. Friedrich H, Haensel-Friedrich G, Langmaak H, Dashner FD. Investigations of cefuroxime levels in cerebrospinal fluid of patients with and without meningitis. Chemotherapy. 1980;26:91–7.

    Article  PubMed  CAS  Google Scholar 

  16. Wong GK, Poon WS, Lyon D, Wai S. Cefepime vs. ampicillin/sulbactam and aztreonam as antibiotic prophylaxis in neurosurgical patients with external ventricular drain: result of a prospective randomized controlled clinical trial. J Clin Pharm Ther. 2006;31:231–5.

    Article  PubMed  CAS  Google Scholar 

  17. Wong GK, Poon WS, IP M, Ng SC. The impact of ventricular catheter impregnated with antimicrobial agents on infections in patients with ventricular catheter: interim report. Acta Neurochir. 2008;102:53–5.

    Article  Google Scholar 

  18. Lucey MA, Myburgh JA. Antibiotic prophylaxis for external ventricular drains in neurosurgical patients: an audit of compliance with a clinical management protocol. Crit Care Resusc. 2003;3:182–5.

    Google Scholar 

  19. Alleyne CH Jr, Hassan M, Zabramski JM. The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. Neurosurgery. 2000;47:1124–9.

    Article  PubMed  Google Scholar 

  20. Langley JM, LeBlanc JC, Drake J, Milner R. Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis. Clin Infect Dis. 1993;1:98–103.

    Google Scholar 

  21. Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW, Blok HE, van der Mark WA, Hanlo PW, et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg. 2010;112:345–53.

    Article  PubMed  Google Scholar 

  22. Girão E, Levin AS, Basso M, Gobara S, Brasileiro L, Medeiros EAS, et al. Trends and outcome of 1,121 nosocomial bloodstream infections in intensive care units in a Brazilian hospital, 1999–2003. Int J Infect Dis. 2008;12:145–6.

    Article  Google Scholar 

  23. Da Silva JMJR, Rezende E, Guimarães T, dos Campos EV, Magno LA, Consorti L, et al. Epidemiological and microbiological analysis of ventilator-associated pneumonia patients in a public teaching hospital. Br J Infect Dis. 2007;11:482–8.

    Article  Google Scholar 

  24. Krol V, Hamid NS, Cunha BA. Neurosurgically related nosocomial Acinetobacter baumannii meningitis: report of two cases and literature review. J Hosp Infect. 2009;71:176–80.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors report no conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil

    E. F. Camacho, Í. Boszczowski, M. Basso, B. C. P. Jeng, M. P. Freire, T. Guimarães, M. J. Teixeira & S. F. Costa

  2. LIM-54, Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    E. F. Camacho, Í. Boszczowski, M. Basso, B. C. P. Jeng, M. P. Freire, T. Guimarães, M. J. Teixeira & S. F. Costa

  3. Medical School, University of São Paulo, São Paulo, Brazil

    S. F. Costa

Authors
  1. E. F. Camacho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Í. Boszczowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Basso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. C. P. Jeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. P. Freire
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Guimarães
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. J. Teixeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. F. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. F. Costa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Camacho, E.F., Boszczowski, Í., Basso, M. et al. Infection rate and risk factors associated with infections related to external ventricular drain. Infection 39, 47–51 (2011). https://doi.org/10.1007/s15010-010-0073-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-010-0073-5

Keywords

Search

Navigation